Radiology Coding Alert

Question: How should I code the following report?

Retrograde barium study through ileostomy:

Clinical Indication: Patient presents with diarrhea and abdominal pain. Recent trauma to the stoma.

Technique: A barium enema tip was placed into the colostomy. The barium enema balloon had been blown up and was used external to the ostomy as a seal while barium was retrogradely infused into the distal ileum. Fluoroscopic evaluation and spot films were obtained in varying projections.

Findings: Abdominal scout view showed a right lower quadrant ileostomy. Surgical clips present in right upper quadrant and in both right and left aspect of the abdomen.

Contrast agent flowed retrogradely into the ileum.

Impression: 1. There is no evidence of peristomal herniation of bowel loops. 2. There is an 11-cm segment of mildly dilated distal ileum.


Washington Subscriber


Answer: Although the study through the ileostomy is a variation on the basic enema, report 74270 (Radiologic examination, colon; barium enema, with or without KUB).

You shouldn't report the films separately, because the National Correct Coding Initiative ( NCCI Edits ) includes a number of services in 74270:
  x-ray codes 74000 and 74010
  therapeutic enema code 74283
  fluoroscopy codes 76000, 76003
  ultrasonic guidance codes 76942 and 76986.   Each of these edits has a modifier indicator of "1," meaning that if the two services are truly separate, you may use the appropriate modifier to unbundle them.

The procedure didn't reveal a new diagnosis, so report the signs and symptoms with 789.00 (Abdominal pain; unspecified site) and 787.91 (Diarrhea).